ANP及KIM-1在脓毒症患者发生急性肾损伤中的变化及意义  

Changes and clinical significance of atrial natriuretic peptide and kidney injury molecule - 1 for acute kidney injury in patients with sepsis

作　　者：徐慧玲[1] 程青虹[1] 李建华[1] 田培刚[1] 何永来[1] 

机构地区：[1]新疆石河子大学医学院第一附属医院ICU,新疆石河子832002

出　　处：《中国急救医学》2013年第6期503-506,共4页Chinese Journal of Critical Care Medicine

摘　　要：目的探讨血心钠肽（ANP）及尿肾损伤分子-1（KIM-1）在脓毒症发生急性肾损伤（AKI）中的动态变化及意义。方法选取自2012—01～2012—09在我院ICU收治的60例脓毒症患者为研究对象，分别在0、2、6、24、48h采集血液及尿液标本，用ELISA法分别检测ANP和KIM-1。根据脓毒症患者是否在住院期间发生AKI，分为脓毒症AKI组、脓毒症非AKI组进行对比分析。结果在ICU住院期间28例患者发生AKI，AKI发生率46．67％。AKI组血ANP在2、6、24、48h和尿KIM-1在6、24、48h高于非AKI组（P〈0．05）；2h血ANP和6h尿KIM-1与确诊AKI时24h血清肌酐（sCr）呈正相关（r=0．959，P=0．000；r=0．938，P=0．000）。2h血ANP和6h尿KIM-1的ROC曲线下面积（AUC）分别为0．865（95％C10．772～0．957）和0．923（95％C10．854～0．992）。结论血ANP和尿KIM-1较sCr更早出现升高，其水平变化可以反映肾损害的严重程度，可以预测脓毒症是否发生AKI。Objective To explore the dynamic changes and clinical significance of atrial natriuretic peptide（ANP） and kidney injury molecule - 1 （ KIM - 1 ） for acute kidney injury in patients with sepsis. Methods From Jan. 2012 to Sep. 2012, total of 60 patients with sepsis were collected at the ICU department of the first affiliated hospital of Shihezi university. Enzyme linked immunosorbent assay（ELISA） was used in the detection of serum ANP and urinary KIM - 1 in 0 h, 2 h, 6 h, 24 h, 48 h all patients with sepsis. Patients with sepsis were divided into sepsis AKI group and non - AKI group according to whether patients with sepsis occurred with acute kidney injury during hospitalization. Also the serum ANP and urinary KIM - 1 of two groups were comparative analysis. Results 28 subjects （46.67%） developed AKI in ICU during the hospitalization. The levels of serum ANP in 2 h, 6 h, 24 h, 48 h and urinary KIM - 1 in 6 h, 24 h, 48 h, with AKI is significantly higher than it in control group（P 〈 0.05）. A significant direct correlation was found between both 2 h serum ANP, 6 h urinary KIM - 1 and 24 h sCr with the diagnosis of AKI （ r = 0.959, P = 0. 000, r = 0. 938, P = 0.000）. The area under ROC of 2 h serum ANP, 6 h urinary KIM - 1 were 0.865 （95 % CI 0.772 - 0.957）, 0. 923 （95% CI 0. 854 - 0.992）. Conclusion Serum ANP and urinary KIM - 1 increases earlier than sCr, which associates with the severity of acute kidney injury. Both 2 h serum ANP and 6 h urinary KIM - 1 can predict the patients with sepsis whether developed to AKI.

关 键 词：心钠肽(ANP) 肾损伤分子-1(KIM-1) 脓毒症 急性肾损伤(AKI) 

分 类 号：R572[医药卫生—消化系统]